U.S. DEPARTMENT OF STATE

Office of the Under Secretary for Global Affairs

Remarks to an INR Conference
on "War Instability and Public Health in Sub-Saharan Africa"
Paula Dobriansky, Under Secretary for Global Affairs
Meridian Center
Washington, D.C.
June 7, 2001

Thank you David for that introduction. And thank you to the Bureau of Intelligence and Research, National Intelligence Council, and the State Department as a whole, for inviting me to join the discussion of this important issue. It is timely and key. Too often we deal with issues like war, political instability, and public health in isolation from each other. Highlighting the linkage between these issues -- as we are doing today -- is so vital to developing a solid policy to combat them and ameliorate their impact.

And that is exactly what I'd like to talk about today, the U.S. Government's policy and our efforts to combat public health concerns and their impact on Africa.

The ongoing tragedy of global infectious diseases -- particularly the global HIV/AIDS pandemic, but also malaria and tuberculosis --is an important foreign policy issue for the United States. It is an issue that the President and the Secretary of State take very seriously and one that they have been and will continue to be engaged in personally. The Secretary has worked closely with the Secretary of Health and Human Services on this issue.

Let me single out our immense concern about HIV/AIDS -- particularly in this period of what people are calling the 20th anniversary of the disease. This is truly a devastating scourge. And truly a national security threat.

As Secretary Powell said during his recent visit to Africa, "there is no war that is more serious, there is no war that is causing more death and destruction, there is no war on the face of the earth right now that is more serious, that is more grave, than the war we see ... in sub-Saharan Africa against HIV/AIDS." It is a war against an enemy that is devastating Africa, its peoples, economies, and societies. And it goes beyond. It is truly a global issue.

Some have questioned how health impacts U.S. security or our interests in Africa. While the link between health and other foreign policy priorities is not always drawn or highlighted, it is very evident to us.

HIV/AIDS and associated diseases kill as many as a quarter of the population in the hardest hit countries, and the emergence and re-emergence of more virulent and antimicrobial resistant strains, pose clear threats to some of the most vulnerable nations and regions in which the U.S. has strategic interests. The devastating impact of diseases like HIV/AIDS is crushing political, economic, and social development in many countries; development that is crucial to our efforts to promote increased security and stable governments, trade, democratic development, and a number of other key foreign policy priorities.

Let's think about the illustrative examples of the impact of disease on each of these areas:

• Social Development: Innumerable children are orphaned by disease or crippled by it themselves. Who will raise them and educate them? Without an educated and healthy future generation, it is virtually impossible for these countries to have strong social, economic, and political development. It hits the fabric of a society.
• Economic Development: With lowering life expectancies, decreasing percentages of healthy adults in the workforce, and increasing burdens on already weak health care systems, how can a country grow economically and expect to be competitive in the international market? It has ramifications for a vibrant workforce.
• Political Development: With these social and economic liabilities, how can a country focus on the extremely challenging tasks of democratization, improving fledgling judicial and legal systems, and developing a thriving civil society? Without these important democratic developments, the likelihood of conflict also rises. All of the areas are intertwined. There are dramatic ramifications for countries.

Simply put, health issues threaten the very development and cornerstones that are necessary for building and maintaining an international community that is stable, democratic, and economically prosperous.

Let me take it one step further and bring it a bit closer to home. HIV/AIDS and other infectious diseases, if unchecked overseas, also directly threaten the health of American citizens. Today, it is not only our diplomats that reach the far flung corners of the world. American businesspeople, students, relief workers, academicians, tourists, -- the list goes on -- are working, living, and travelling in almost every corner of the world. This is another reason why promoting international health is one of the Department of State's strategic goals.

Now let me briefly outline the scope of the problem and then talk about how we are combating it.

The scope of infectious diseases -- particularly of HIV/AIDS -- is truly unprecedented, and it threatens to reverse decades of political development, economic growth, and social progress. And sub-Saharan Africa is at the center of this.

• The United Nations Joint Program on HIV/AIDS (UNAIDS) estimates that 36 million people are now living with the virus, 70% (over 25 million) in sub-Saharan Africa, where it is now the leading cause of death.
• Tuberculosis accounted for 1.7 million deaths last year, while malaria killed more than one million, mostly children in Africa.

Women and girls experience the highest rates of infection. UNAIDS estimates that in sub-Saharan Africa, there are 13.2 million women living with HIV/AIDS compared to 10.9 million men. As part of the workforce, primary care givers, and mothers, this has a devastating impact on societies. We must recognize the increasing number of women with HIV and take this issue into account as we continue education, testing, counseling, care and treatment designed to address the specific needs of women and girls. And we cannot underestimate the devastating impact of the HIV/AIDS epidemic on refugees -- especially in Africa.

Let me note, however, that even though Africa is truly at the center of this pandemic, we are focusing our attention and resources globally to include Asia, Russia, and the New Independent States, and parts of the Western Hemisphere -- especially the Caribbean. Diseases obviously know no boundaries, so we continue to target our efforts globally.

Let me turn to what we are doing about these diseases.

The State Department coordinates the U.S. Government's foreign policy to combat the spread of infectious diseases of epidemic or pandemic proportions. We are leading the interagency development of a strategy to expand USG HIV/AIDS engagement beyond Africa to other high-threat regions, including Southeast Asia and China, India, Russia, Central Asia, and the Caribbean. And we are engaged with the interagency community to ensure that USG funding is programmed effectively in terms of national interest, humanitarian need, impact on social and economic sectors, and other criteria. We are working closely with other parts of the government. There is a taskforce that deals with this issue. It is chaired by the Secretary and Secretary Thompson of HHS.

Because this is not a battle that we can or should fight alone, we are working with the EU and other donor partners in Africa and identifying international partners with whom we can collaborate in other regions of the world. It is imperative that our partners match our financial commitment to fighting HIV/AIDS and other emerging and infectious diseases. The Japanese are very concerned about HIV/AIDS, as well as malaria and tuberculosis in Asia.

The United States has been, and will continue to be, the largest bilateral donor in the fight against HIV/AIDS, TB, and malaria, providing nearly 50% of international assistance for these three diseases.

President Bush's FY 2002 budget proposal reflects the U.S. commitment to help those with HIV/AIDS and other infectious diseases, and to support research and development for new interventions for treatment and cures. Let me run through what the president's proposed budget does. It:

• Allocates $480 million to fight HIV/AIDS globally, a 113% increase over FY 2000;
• Dedicates $10.2 billion in the HHS budget to fight HIV/AIDS, an increase of 7.2%;
• Provides $2.5 billion for the National Institutes of Health for HIV/AIDS research, an increase of $258 million, and
• Provides up to an additional $11 million targeted to HIV/AIDS prevention and care in refugee settings, the first such targeted funding for this population.

Under President Bush's leadership, the United States will continue to pursue an integrated approach to fighting disease, focusing on the prevention of new infections, and training medical professionals, as well as treatment and care.

Let me say that it is not only money that will make the difference in this battle. It will be truly understanding the epidemiology of the disease within each demographic group, to change trends. It means a bottom-up prevention and treatment plan that includes appropriate delivery systems, involvement of communities, NGOs, and unquestionably, full support of the national governments.

We hope that the global fund will be part of this effort. The President announced on May 11 that the United States is prepared to commit $200 million to the fund focused on the fight against these three diseases; $200 million in private sector funds will also be made available.

I can't stress enough that this is a global campaign. Our allies must contribute to this fund for the fund to be effective. It cannot work without full support from other members of the international community.

The United States will continue to work with other countries to ensure that the global fund:

• Is a public-private partnership;
• Pursues an integrated approach, emphasizing prevention in a continuum of treatment and care;
• Focuses on "best practices" by funding a core menu of programs proven to work, then scaling up;
• Promotes scientific and medical accountability by requiring proposals to be reviewed for effectiveness by medical and public health experts; and
• Respects intellectual property rights as an important incentive for the development of new drugs.

We are also working very hard in the run-up to the June 25-27 UN General Assembly Special Session on HIV/AIDS to develop this fund proposal to attract the global contributions envisioned by the international supporters of this fund.

All of this effort and financial support is an indication of the Administration's serious commitment to fighting these diseases and a recognition of the impact they have on our national security interests and other foreign policy priorities.

Thank you for having me here today. I applaud the efforts to discuss the important link between these issues, and look forward to continued dialogue and work on this issue. This is a very important issue that the President and Secretary are very committed to working on in the U.S. and globally.

END